Yashwant Kumar Rao

Effect of vitamin D supplementation on growth parameters of children with vitamin D deficiency: a community based randomized controlled trial

Background: Vitamin D deficiency remains the most common cause of rickets globally and is highly prevalent in developing countries including India. This study aimed to compare the efficacy of vitamin D and calcium together with calcium alone on growth parameters of children with vitamin D deficiency in community based setting. Methods: A randomized controlled trial was conducted in community based setting in Kanpur district. Multistage random sampling technique was used to select a total of 395 children between 2 years to 5 years from 5 villages of block Vidhunu. Of these, 138 children were randomized into two groups using balanced block randomization technique. Group 1 received vitamin D with calcium together and group 2 received calcium alone for a period of 12 months. Anthropometry, serum vitamin D, calcium, alkaline phosphatase levels were estimated at baseline and after 12 months. Data was analyzed using SPSS 20. Student’s t test was used to analyze the differences in growth and laboratory parameters in the two groups. Multiple linear regression analysis was used to assess the effect of various factors on the growth parameters. Results: Prevalence of vitamin D deficiency was 78.7%. Baseline characteristics of both groups were similar. After 12 months, group 1 demonstrated significantly greater improvement in weight SD score (21.4%) and height SD score (10.3%) and growth velocity (9.1 cm/year) compared to group 2 (14.3%, 7.8% and 6.9 cm/ year respectively). Also subjects in group 1 showed significantly greater improvement in serum levels of vitamin D, calcium and alkaline phosphatase than group 2. Conclusions: Vitamin D supplementation along with calcium improves the growth of children. Regular supplementation of all children with vitamin D can be considered as a policy for prevention of malnutrition.

Anthropometric indicators as predictor of pre-diabetes in Indian adolescents

Introduction In India, there are approximately 41 million diabetics to date. Impaired glucose tolerance or pre-diabetes may occur as early as adolescence. Objective To find out the cut-off values of body mass index (BMI) and waist circumference to predict pre-diabetes in adolescents in north India. Methods A cross-sectional study was conducted among 526 students aged 17–19 years, in the Institute of Paramedical Sciences, Chatrapati Shahuji Maharaj University, Kanpur. A pre-tested questionnaire was used and the diagnostic criteria of the American Diabetic Association were applied. Receiver operating characteristic(ROC) analysis was used to assess the cut-offs of BMI and waist circumference for predicting prediabetes. Results ROC analysis showed that BMI is a good predictor of prediabetes for both boys and girls.Area under the ROC curve was 0.828 for boys and 0.838 for girls, respectively. The cut-off values of BMI for predicting prediabetes were identified as ≥22.8 kg/m2 in boys and ≥20.5 kg/m2 in girls. Upon ROC analysis for waist circumference, it was observed that it was a good predictor of prediabetes both for boys (area under the curve 0.804) and girls (area under the curve 0.795). The cut-offs for waist circumference for predicting prediabetes were found to be ≥82.5 cm for boys and ≥80.3 cm for girls. Conclusion BMI and waist circumference estimation can be done for early detection of prediabetes in adolescents for further diagnostic evaluation and management.

A study on the prognostic value of core to peripheral temperature gradient and blood lactate levels in critically ill children in a tertiary care hospital in Kanpur, India

To assess the prognostic value of core to peripheral temperature gradient and blood lactate levels in critically ill children and determine their correlation in terms of patient outcome. It is a prospective observational study conducted on 99 patients admitted in the pediatric emergency ward/ICU of Deptt. Of Pediatrics, G.S.V.M. Medical College, Kanpur. Children between ages of 6 months to 18 years with sequential organ failure assessment (SOFA) score > 5 were included. ROC analysis and multiple logistic regression analysis were used to analyse the data. ROC curve analysis showed that core to peripheral temperature gradient and blood lactate levels had similar predictive values for increased risk of death (area under the curve, 0.852 and 0.825, respectively) with the best cut-off values of 3.4° C for core to peripheral temperature gradient and 44 mg/L for blood lactate levels. Among infants aged 6 months to 18 years, core to peripheral temperature gradient and blood lactate levels are good prognostic indicators in identifying critically ill children at increased risk of death.

Variation in the clinical presentation of Plasmodium vivax and Plasmodium falciparum malaria in children: A hospital based study in Kanpur, India

In India, Plasmodium falciparum is recognized as an important cause of pediatric mortality and morbidity. However, recent observations suggest there is an increasing incidence of severe cases of P. vivax , including acute renal failure. All patients in the age group 0–15 yr, presenting with fever, admitted to the Department of Pediatrics, GSVM Medical College, Kanpur, during the study period were tested for malarial parasites. Those positive for P. vivax and/or P. falciparum were included in the study; clinical findings and laboratory investigations were recorded and analysed. A total of 112 subjects belonging to the age group 0–15 yr were included in the study. P. vivax was detected in 70 (62.5%) and P. falciparum in 42 (37.5%). Many patients with P. vivax demonstrated signs and symptoms of severe malaria, including respiratory symptoms in 12 (17.1%), abdominal symptoms in 39 (55.7%), central nervous system symptoms in 19 (27.1%), pallor in 60 (85.7%), icterus in 9 (12.9%), edema in 15 (21.4%), hypotension in 3 (4.3%), hepatomegaly in 49 (70%) and splenomegaly in 51 (72.9%). 12.9% of P. vivax patients had acute renal failure (ARF). There is a rising incidence of P. vivax cases causing severe malaria. ARF, which was previously considered to be only due to P. falciparum , is now also caused by P. vivax. P. vivax should no longer be considered a benign species causing only non-severe malaria.

Pediatric intestinal leiomyosarcoma

The paper reports an infant presenting with leiomyosarcoma of the small intestine. The patient presented with intermittent abdominal pain. Examination revealed a hard and mobile intraperitoneal mass. The tumor arose from the mid-ileum with regional lymphadenopathy. Excision of the tumor along with the involved bowel was performed followed by three cycles of chemotherapy. Histological diagnosis was that of a low-grade malignant leiomyosarcoma of the small intestine. Surgical excision was followed by three cycles of chemotherapy. After surgery and three cycles of chemotherapy, the patient was followed up for four years with no evidence of recurrence or metastasis. Surgery followed by chemotherapy was curative for leiomyosarcoma in our patient. Intestinal leiomyosarcoma should be kept as a differential diagnosis for mobile solid intraabdominal tumors in childhood.